It was OCD Awareness Week last week. It was timely that the Sunday, October 7th evening broadcast of “60 Minutes” featured an interview with John Green, author of The Fault in Our Stars. Before the interview, I only knew that he was a good writer, and that he has a great sense of humor. What I didn’t know, before this interview, was that he suffers from OCD as does approximately two percent of the population. Often, when we think of OCD, we imagine an individual who is incessantly washing hands due to contamination fears or flipping a light switch eight times to ward off a disaster of some type. However, there are many ways OCD can show up and affect a person’s life. It is important to note that OCD may be present whether one has only obsessions or compulsions. Both may be present but that is not a requirement for the diagnosis or treatment. Often, but not always, obsessions and/or compulsions develop in adolescence or even earlier (boys typically earlier than girls). Obsessions consist of unwanted, repetitive, intrusive thoughts, ideas, and/or images that limit quality of life and, in some cases, one’s child or adult development as fears restrict experiences, whereas a compulsion is a behavior/action that helps to reduce anxiety and fear. Several examples of compulsions include avoidance, rituals, counting, making lists, or rearranging things. These strategies are used to decrease the anxiety caused by the obsession. For instance, I may have an extreme fear that I will cause my mother to die if I don’t get ready for work in the exact same order every day. So, a ritual is developed so that a loved one won’t be harmed.
Some individuals suffering from the illness are terrified by intrusive images such as harming their child. They would never do such a thing, but they are tormented by the image and can’t get it out of their mind. Others are terrified of having an impulse to harm themselves, and it is not at all associated with depression and hopelessness. The thought just happened to be there one day and simply won’t go away. Obsessive thoughts are quite unpleasant and distress the individual. When anxiety is high, sometimes a compulsion is used to discharge the discomfort, but the relief is only temporary, and the cycle will continue to repeat. Other types of obsessions include disturbing sexual or religious thoughts. The good news is that a combination of medication and behavior-based therapy can be extremely helpful by reducing the intensity of the OCD. Cognitive Behavioral Therapy and Exposure Response Prevention (ERP) Therapy are evidence-based treatments for OCD, and these are the therapies I use to help my clients. While medication can be an important component of treatment, some people don’t want to take it. It can be helpful but not always necessary depending on the individual, circumstances, and severity of the disorder. In less severe cases, we try therapy alone and refer to a psychiatrist if medication recommendations appear necessary.
If you suffer from this illness, the psychotherapy and psychiatric communities are here to help you. Additionally, the International OCD Foundation (IOCDF) has a helpful website providing a variety of resources. At this time, I would like to acknowledge the many brave people who suffer from OCD while trying to lead their best lives. From my clinical experience, I appreciate how challenging this mental illness can be and how one can be helped with the right treatment. John Green talked about what has helped him, and I was particularly touched when he said, “You can have a mental illness and still have a good life.” An important message.